Reuters Health Information (2005-10-24): Better survival at level I trauma centers after most-severe injuries
Better survival at level I trauma centers after most-severe injuries
Last Updated: 2005-10-24 15:00:29 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Survival after the most
severe injuries is significantly better at level I trauma centers than
at level II trauma centers, according to a report in the October Annals
"Although it is the first study to show this difference, it is not
an unexpected finding," Dr. Demetrios Demetriades from University of
Southern California, Los Angeles, told Reuters Health. "Level I centers
are academic facilities with stricter requirements and more resources."
Dr. Demetriades and colleagues compared outcomes of 12,254 trauma
patients with specific severe injuries after treatment at level I or
level II trauma centers. The injuries included aortic, vena cava, iliac
vessels, grade IV or V liver injuries, penetrating cardiac injuries,
quadriplegia and complex pelvic fractures.
Overall mortality among patients treated at level I trauma centers
was 25.3%, the authors report, compared with 29.3% at level II trauma
centers. After adjustment for injury severity scores, the mortality at
level I trauma centers was nearly 20% lower than that at level II
trauma centers or all other centers.
The difference was most apparent for patients with severe liver
injuries or cardiovascular injuries, the results indicate; there was no
survival difference for patients with quadriplegia or complex pelvic
Functional outcomes at discharge were better overall at level I
centers, the researchers note, with a significantly lower incidence of
total functional independence in survivors (20.3%) compared with level
II centers (33.8%).
The volume of severe trauma did not influence mortality at level I or at level II centers, the report indicates.
"The current study has provided strong evidence that American
College of Surgeons-designated level I trauma centers have
significantly better survival and functional outcomes than level II or
other trauma centers for select severe injuries," the authors write.
"This finding may have practical implications in the planning of trauma
systems, triage of patients to trauma centers, and financial
compensation of services according to level of center accreditation."
"The public must understand that both level I and II trauma centers
are essential for an effective trauma system," Dr. Demetriades added.
"Logistically and practically you need to have both levels. The
injuries that benefited from level I centers are only about 1% of all
trauma admissions. It is not advisable to build a trauma system based
exclusively on this 1% of the victims."
Ann Surg 2005;242:512-519.